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01 <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 � <br /> � " o <br /> TO THE ZONINO ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> CP <br /> . Qrt n1. Q n...................................... .�.. .. . X0.5...��.:... 1. .................. H o <br /> OWNER (please print) RAR or URVEYOR or AGENT o. <br /> L . <br /> ........................................................................................... <br /> . .,...�VA..........G........................................ <br /> ADDRESS A KESS ' <br /> �` 8 � ap..i.. ....... . .. .. . .................... <br /> ADDRESS ADDR!.ESSvv <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .......'R' 'E' ............................................................................... y � <br /> ADDRESS ADDRESS L <br /> 0 o <br /> ........................................................................................... ...PH..O...NE.................................................................................... Z o .: <br /> PHONE <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o ' <br /> New Building .,.,,. Type of Construction: No. Bedrooms .......... a <br /> m <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... < <br /> Sanitary Size ft. x ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... <br /> Mobile Home Slope ............................ O <br /> .............. 0 <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ..........................I........ <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision •, Seepage Trench .......... <br /> .............................................I...... <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed <br /> .......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL FXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ---------9— ---------------------------- '� <br /> 5. Lot Size: Fi A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> N O <br /> OQ <br /> r <br /> z <br /> L <br /> m O <br /> Z �\ <br /> O C <br /> S <br /> d <br /> ' ^ O <br /> r <br /> m <br /> t,l _. <br /> X rn r- M :E m z <br /> to <br /> "O Co <' C m <br /> m <br /> Z o o D a <br /> O O n <br /> /C1/off .......... - <br /> a m <br /> 0 <br /> o C <br /> Signaturof Owner or Agent ate <br /> X rn <br /> e <br /> Remarks ......................................................................................................................................................................... <br /> m <br /> v <br /> ............................................................................................................. .............. <br /> n <br /> Inspection Date ....................................... N rtmt <br /> �. .............. ..................................... \ o morn <br /> ell Zoning ministrator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures inVoIViny sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />